SPINAL TUBERCULOSIS SANIA JACKSON UTMA (GM) 502 INTRODUCTION • Evidence of spinal TB dates back to Egyptian times and has been documented in 5000-year-old mummies. • In 1779, Percival Pott published the first modern description of spinal deformity and paraplegia resulting from spinal TB. • According to WHO(2006), about one third of the world’s population is infected by Mycobacterium TB, and 9 million individuals develop TB each year. • One fifth of TB population is in India. • Three percent are suffering from skeletal TB. • Vertebral TB is the most common form of skeletal TB and accounts for 50% of all cases of skeletal TB. • Almost 50% are from pediatric group. • Every day 1000 die of tuberculosis in India. • Neurological complications are the most crippling complications of spinal TB ( Incidence : 10 to 43%). SPINAL TUBERCULOSIS Pathology • Spinal tuberculosis is usually a secondary infection from a primary site in the lung or genitourinary system. • Spread to the spine is hematogenous in most instances. • Delayed hypersensitivity immune reaction. • Initially : a pre-pus inflammatory reaction with Langerhan’s giant cells, epithelioid cells, and ymphocytes. • The granulation tissue proliferates, producing thrombosis of vessels. SPINAL TUBERCULOSIS • Tissue necrosis and breakdown of inflammatory cells result in a paraspinal abscess. • The pus may be localized, or it may track along tissue planes. • Progressive necrosis of bone leads to a kyphotic deformity. • Typically, the infection begins in the anterior aspect of the vertebral body adjacent to the disk. • The infection then spreads to the adjacent vertebral bodies under the longitudinal ligaments. • Noncontiguous (skip) lesions are also seen occasionally SPINAL TUBERCULOSIS DIAGNOSIS • RADIOLOGICAL DIAGNOSIS • 1. PLAIN RADIOGRAPH • 2. CT SCAN • 3. MRI SPINE • 4.BONE SCAN TB bacilli are rarely found in CSF, therefore imaging plays pivotal role in suggesting the diagnosis. 2. Spinal Arachnoiditis • Frequently involves the spinal cord, meninges and the nerve roots and is more appropriately referred to as radiculomyelitis (TBRM) . Should be suspected when patient develops spinal cord symptoms. • PATHOGENESIS : 1. Hematogenous spread from extra CNS source. 2. Secondary extension of intracranial disease. 3. Secondary intraspinal extension from tuberculous spondylitis. Gross granulomatous exudates fill the subarachnoid space. With time exudates get organized and fibrin coated nerve roots adhere to each other. Vasculitis of spinal arteries may cause spinal cord ischemia. COMPLICATIONS OF SPINAL TUBERCULOSIS • Paraplegia • Cold abscess • Spinal deformity • Sinuses • Secondary infection • Amyloid disease • Fatality THANK-YOU !